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Biomedical subjects

F Alan Barber

Publications and source records attributed to F Alan Barber.

31 records · Page 2Linked to original sources
PubMed2004

Load to failure testing of new meniscal repair devices.

PURPOSE: New all-inside meniscal repair devices include those combining sutures with anchors and that allow for an "adjustable" repair. This study's purpose was to compare the failure strength of new meniscal repair devices with suture repairs. TYPE OF STUDY: Experimental laboratory biomechanical study. METHODS: A single repair was placed in a vertical longitudinal peripheral tear made in fresh adult porcine menisci. Group 1 had a vertically oriented suture using the FasT-Fix (Smith & Nephew Endoscopy, Andover, MA) device. Group 2 had a horizontally oriented mattress suture using the FasT-Fix device. Group 3 had a repair using 2 Arthrex (Naples, FL) meniscal darts. The Group 4 repair used a RapidLoc (Mitek Surgical Products, Westwood, MA) device. The Group 5 repair used the Arthrotek meniscal screw (Biomet, Warsaw, IN). Group 6 had a single vertical suture, and group 7 a single horizontal suture, both of 2-0 Mersilene (Ethicon, Somerville, NJ). Load to failure testing was performed. RESULTS: The vertical FasT-Fix suture had a mean load to failure of 70.9 N (1 SD +/- 33). The horizontal FasT-Fix suture had a mean load to failure of 72.1 N (+/- 23.5). The double Dart repair had a mean load to failure of 61.7 N (+/- 19). The RapidLoc repair had a mean load to failure of 43.28 N (+/- 3.98). The Arthrotek meniscal screw repair had a mean load to failure of 28.09 N (+/- 7.93). Failure occurred with device pullout of the inner rim (9 of 10) for the Darts, device pullout of the inner rim (6 of 10) and pullout of the outer rim (4 of 10) for the Arthrotek screw, and suture breakage for the FasT-Fix and the RapidLoc devices. The vertical sutures' mean load to failure was 80.43 N (+/- 8.5), and all 13 failed by suture breaking. The horizontal sutures' mean failure load was 55.9 N (+/- 18.8), and failure was by both suture breaking (6 of 10) and pulling through the meniscal tissue (4 of 10). CONCLUSIONS: Some of the newer meniscal repair devices show improved loads to failure over earlier generations.

Animals↗
PubMed2003

Sutures and suture anchors: update 2003.

PURPOSE: The purpose of this study was to evaluate recently introduced sutures and suture anchors for single-pull load-to-failure strength and failure mode. TYPE OF STUDY: Experimental laboratory biomechanical study. METHODS: Using an established protocol in fresh porcine femurs, anchors were tested in diaphyseal cortex, metaphyseal cortex, and cancellous troughs after threading them with either steel sutures or strong synthetic material to reduce the likelihood of suture breakage as a mode of failure. An Instron machine (Instron, Canton, MA) applied tensile loads parallel to the axis of insertion at a rate of 12.5 mm/second until failure, and mean anchor failure strengths were calculated. Mode of failure was recorded (anchor pullout, suture eyelet cutout, or wire breakage). Anchors tested included the RotorloC (Smith & Nephew Endoscopy, Andover, MA), TwinFix Ti 3.5, TwinFix Ti 5.0, and TwinFix AB (Smith & Nephew Endoscopy), Super Revo and UltraSorb (Linvatec, Largo, FL), Duet (Bionx Implants, Blue Bell, PA), AlloAnchor RC (Regeneration Technologies, Alachua, FL), Opus Magnum anchor (Opus Medical, San Juan Capistrano, CA), and the BioCorkscrew 5.0 and BioCorkscrew 6.5 (Arthrex, Naples, FL). Sutures tested were No.2 and No. 5 Ethibond (Ethicon, Somerville, NJ), No. 2 Panacryl (Mitek, a division of Ethicon, Somerville, NJ), and Nos. 2, 5, and 2-0 Fiberwire (Arthrex, Naples, FL). RESULTS: The sutures all broke in the midpoint of their tested strand away from the grips. The No. 2 Ethibond failed at a mean of 21 lb (92 N); No. 5 Ethibond failed at a mean of 44 lb (193 N); No. 2, No. 5, and No. 2-0 Fiberwire at means of 44 lb (188 N), 112 lb (483N), and 19 lb (82 N), respectively; and No. 2 Panacryl at a mean of 22 lb (99 N). The suture anchors all failed at levels higher than the associated sutures. CONCLUSIONS: Screw anchors showed higher load to failure values than nonscrew designs, and the new biodegradable anchors showed failure loads lower than the anchors. All anchors were stronger than the suture for which they are designed.

Animals↗
PubMed2003

Iliotibial band Z-lengthening.

Iliotibial band friction syndrome (ITBFS) is a common overuse injury reported to afflict 1.6% to 12% of runners. It results from an inflammatory response secondary to excessive friction that occurs between the lateral femoral epicondyle and the iliotibial band. Initial treatments include rest, anti-inflammatory medication, modalities (ice or heat), stretching, physical therapy, and possibly a cortisone injection. In recalcitrant cases of ITBFS, surgery has been advocated. This report describes a surgical technique of Z-lengthening of the iliotibial band in patients presenting with lateral knee pain localized to the iliotibial band at the lateral femoral epicondyle and Gerdy's tubercle who failed all nonoperative efforts.

Anti-Inflammatory Agents↗
PubMed2002

The effectiveness of an anesthetic continuous-infusion device on postoperative pain control.

PURPOSE: To evaluate the effectiveness of an anesthetic continuous-infusion device on postoperative pain after outpatient shoulder surgery. TYPE OF STUDY: Double-blinded randomized trial. METHODS: A prospective, double-blinded, randomized study of 50 consecutive patients undergoing outpatient arthroscopic shoulder surgery was performed. Patients were assigned by computer-generated randomized permuted block of four to 2 groups (25 each) receiving either a saline or 0.5% bupivacaine solution via an infusion pump after surgery. All patients gave informed consent and were randomized immediately before surgery. The surgical team, patient, clinic staff, and data collector were blinded to the randomization. Procedures performed included arthroscopic rotator cuff repairs, SLAP lesion repairs, subacromial decompressions, and capsular reefings. The infusion pump that was tested was used continuously for 48 hours and administered 2 mL each hour. For subacromial and rotator cuff surgery, the catheter was placed in the subacromial space. For glenohumeral surgery, the catheter was placed in the glenohumeral joint. Routine pain-control efforts were continued. Interviews were conducted at 1, 2, and 8 hours after surgery, followed by daily telephone interviews for 1 week. Visual analog scale (VAS), categorical pain scale (Likert) data, and oral medication use data were recorded. RESULTS: Complete data sets were collected from 25 bupivacaine and 24 saline patients because 1 pump malfunctioned and was removed early. The average age of the bupivacaine group patients was 47.4 +/- 16.3 years (range, 16 to 84); patients in the saline group had an average age of 46.0 +/- 15.5 years (range, 19 to 73). There were 17 men and 8 women in the bupivacaine group and 16 men and 8 women in the saline group. The Likert and VAS mean values showed lower pain scores for the patients using the pump containing bupivacaine than for the saline group at all recorded times (P <.05) throughout the 7 days of data collection. The interval of greatest pain was on day 2. Postoperative oral medication use was always greater for the saline group than for those receiving bupivacaine. CONCLUSIONS: Postoperative pain control after arthroscopic shoulder surgery is essential so that these procedures can be successfully carried out in an outpatient setting. The first 2 postoperative days is the period of greatest pain. Continuous postoperative bupivacaine infusion is effective during this critical period, and the effect lingers even after the infusion is discontinued. The administration of bupivacaine via a continuous-infusion anesthetic pump statistically reduced postoperative pain after outpatient arthroscopic rotator cuff repairs, SLAP lesion repairs, subacromial decompressions, and capsular reefings.

Acetaminophen↗
PubMed2002

The effect of the EndoPearl on soft-tissue graft fixation.

This study determined whether EndoPearl (Linvatec Corp, Largo, Fla) secondary fixation to an interference screw increased the fixation strength of a soft-tissue tendon graft. Ten-millimeter porcine patellar tendon grafts with attached patellae were harvested without a tibial bone plug and inserted into 9-mm tibial tunnels to test a nonlooped solid tendon graft. Twenty grafts were fixed with a BioScrew (Linvatec Corp, Largo, Fla) and 20 with BioScrew/EndoPearl combinations. These were tested with straight line destructive loads at 60 mm/min without cycling and after 500 cyclic loads. Tendons were secured with nonlocking (Bunnell) sutures along both edges and then passed through the central hole of the EndoPearl. A significant decrease in stretch at maximum force was noted between specimens that were cyclically loaded prior to testing and those that were not (P<.001); a significant increase in energy absorption between specimens with and without EndoPearl in the straight destructive test (P<.02); and a significant increase in stiffness with cyclic loading (P<.001). A positive correlation also was noted between failure force and insertion torque (P=.02). The EndoPearl increased energy absorption at failure. Solid tendon grafts consistently failed due to the sutures tearing out of the tendon and the tendon sliding by the interference screw. The Bunnell stitch was the weakest link and is not effective for this graft.

Absorbable Implants↗
PubMedDate not supplied

Arthroscopic Bankart reconstruction with a bioabsorbable anchor.

This study evaluated the clinical effectiveness of a poly-l-lactic acid biodegradable suture anchor for arthroscopic Bankart reconstruction with a prospective multicenter study. Inclusion criteria were one or more episodes of traumatic dislocation or multiple posttraumatic subluxations as a manifestation of unidirectional anterior instability. Exclusion criteria were significant glenoid bone deficiency, large Hill-Sachs lesions, rotator cuff tears, multidirectional instability, posterior labrum tears, or biceps ruptures. Fifty-seven patients were followed up for a mean of 24 months. Postoperative apprehension tests were negative in all but two. Motion improved from 155 degrees preoperatively to a mean of 175 degrees postoperatively. Four patients had postoperative instability symptoms (two dislocators and two with subluxations). Postoperative radiographs demonstrated no lytic or resorptive bone changes from the suture anchors. The mean postoperative Rowe score was 93. The biodegradable suture anchor achieved good clinical results when used for arthroscopic Bankart reconstruction with no material-related adverse events.

Absorbable Implants↗
PubMedDate not supplied

Repair of quadriceps tendon ruptures using suture anchors.

The repair of ruptured quadriceps tendon is commonly performed by weaving sutures through the ruptured tendon and then attaching the tendon to the bone by passing these sutures through tunnels in the superior patella. This technical note is the first report we are aware of in the English language literature of a technique that uses suture anchors to attach the tendon to bone.

Basketball↗
PubMedDate not supplied

The effect of outlet fixation on tunnel widening.

PURPOSE: To compare the development of tibial tunnel widening after a standard bone-patellar tendon-bone autograft (BPTB) to a flipped BPTB that allows interference screw outlet fixation with a bone plug at both femoral and tibial tunnels, and to identify any observable clinical effect. The hypothesis of this study was that the outlet fixation achieved by the flipped BPTB technique results in diminished tunnel widening at the site of the bone plug. Type TYPE OF STUDY: Nonrandomized control trial. METHODS: The postoperative radiographs of 67 BPTB anterior cruciate ligament (ACL) reconstructions were retrospectively reviewed; 31 had conventional BPTBs and 36 had the bone plugs flipped at the tibial end to achieve interference screw fixation of the bone plug at the tibial outlet as well as the femoral outlet. Biodegradable interference screws (PLLA) were used in all cases, which facilitated tunnel measurements. One week after surgery, the maximal tibial bone tunnel widths were measured on anteroposterior and lateral radiographs 1 cm below the tibial plateau. These initial postoperative measurements were compared with measurement from radiographs taken annually thereafter. Clinical information including Lysholm, Tegner, IKDC activity, Lachman, pivot-shift, and range of motion data was also obtained and compared for the 2 groups. RESULTS: In the conventional BPTB group, at an average follow-up of 28 months, 28 of 31 (90%) showed at least a 2-mm increase (20%) in the tibial tunnel width. The mean maximum tunnel width increase was 2.2 mm. In the flipped BPTB group, at an average follow-up of 31 months, none of these 36 showed any increase in tunnel size. In fact, 15 patients had no distinct tibial tunnel remaining and, of the other 21, the average remaining tunnel width was 3 mm. The clinical results evaluating the Tegner, Lysholm, IKDC activity levels, KT, and physical examination parameters showed no significant differences between these 2 groups. The tunnel width decreased during the first year, but remained unchanged after 12 months. No tunnel dilation was observed with bone plug outlet fixation while 90% of the conventional group had at least a 20% increase (P <.001). CONCLUSIONS: Outlet fixation with the flipped BPTB technique decreased the tibial tunnel width 1 cm below the plateau while 90% of the conventional BPTB patients demonstrated an average widening of 20%.

Adult↗